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在急性A型大动脉解剖中,先进行内血管透/支架,然后进行延迟的大动脉开放修复
Bo Yang1, Carlo Maria Rosati1, Elizabeth L Norton2
1Departments of Cardiac Surgery (B.Y., C.M.R., K.M.K., X.W., H.J.P., G.M.D.), Michigan Medicine, Ann Arbor.
Circulation
|November 27, 2018
概括
在急性A型大动脉剖析中,通过循序渐进的内血管再注血,然后进行开放性修复 (OR) 改善了结果. 与立即开放修复相比,这种策略降低了所有患者的死亡率.
科学领域:
- 心血管外科
- 胸部手术
- 血管外科
背景情况:
- 传统上,急性甲动脉解剖要求立即进行开放性修复 (OR),以防止破裂.
- 由于某些患者的器官衰竭,透综合征 (MPS) 具有迫在眉的危及生命的风险.
- 对于MPS的急性A型大动脉解剖的最佳管理策略仍在讨论中.
研究的目的:
- 评估MPS急性A型大动脉剖析的分阶段方法的结果.
- 为了比较二十年的治疗策略之间的死亡率.
- 评估前期内血管再输的有效性,然后延迟OR.
主要方法:
- 从1996年到2017年对597名急性甲动脉剖析患者进行了回顾性分析.
- 专注于135名患有MPS的患者,他们接受了前置内血管化/支架和延迟OR治疗.
- 两十年间的结果与预后模型的比较.
主要成果:
- 在这20年间,整体住院死亡率从21.0%大幅上升至10.7%.
- 在第二个十年,使用内血管方法治疗的MPS患者中,大动脉破裂的死亡率降至4%.
- 在MPS患者中,因器官衰竭的死亡风险明显高 (HR=6. 63),而不是由于破裂.
结论:
- 立即OR适用于大多数急性甲动脉剖析患者,以防止破裂.
- 一个分阶段的方法 (内血管再输血然后OR) 有利于稳定的MPS患者,因为它允许器官衰竭的解决.
- 这种分阶段的策略显著降低了30天和住院死亡率,与所有传统的预先OR相比.
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